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Li J, Bian Y, Wu F, Fan Z, Zhang C, Zhao X, Ji X, Yang Q. Association of Morphology of Lenticulostriate Arteries and Proximal Plaque Characteristics With Single Subcortical Infarction: A Whole-Brain High-Resolution Vessel Wall Imaging Study. J Am Heart Assoc 2024; 13:e032856. [PMID: 38726896 PMCID: PMC11179825 DOI: 10.1161/jaha.123.032856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/15/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND We aimed to investigate the association of characteristics of lenticulostriate artery (LSA) morphology and parental atheromatous disease (PAD) with single subcortical infarction (SSI) and to explore whether the LSA morphology is correlated with proximal plaque features in asymptomatic PAD. METHODS AND RESULTS Patients with acute SSI were prospectively enrolled and classified as large- and small-SSI groups. The clinical data and imaging features of LSA morphology (branches, length, dilation, and tortuosity) and middle cerebral artery plaques (normalized wall index, remodeling index, enhancement degree, and hyperintense plaques) were evaluated. Logistic regression was performed to determine the association of large SSIs with morphologic features of LSAs and plaques. The Spearman correlation between the morphologic characteristics of LSAs and plaque features in asymptomatic PAD was analyzed. Of the 121 patients recruited with symptomatic PAD, 102 had coexisting asymptomatic contralateral PAD. The mean length of LSAs (odds ratio, 0.84 [95% CI, 0.73-0.95]; P=0.007), mean tortuosity of LSAs (odds ratio, 1.13 [95% CI, 1.05-1.22]; P=0.002), dilated LSAs (odds ratio, 22.59 [95% CI, 2.46-207.74]; P=0.006), and normalized wall index (odds ratio, 1.08 [95% CI, 1.01-1.15]; P=0.022) were significantly associated with large SSIs. Moreover, the normalized wall index was negatively correlated with the mean length of LSAs (r=-0.348, P<0.001), and the remodeling index was negatively correlated with the mean tortuosity of LSAs (r=-0.348, P<0.001) in asymptomatic PAD. CONCLUSIONS Our findings suggest that mean length of LSAs, mean tortuosity of LSAs, dilated LSAs, and normalized wall index are associated with large SSIs. Moreover, plaque features in asymptomatic PAD are correlated with morphologic features of LSAs.
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Affiliation(s)
- Jin Li
- Department of Radiology Beijing Chaoyang Hospital, Capital Medical University Beijing China
| | - Yueyan Bian
- Department of Radiology Beijing Chaoyang Hospital, Capital Medical University Beijing China
| | - Fang Wu
- Department of Radiology Xuanwu Hospital, Capital Medical University Beijing China
| | - Zhaoyang Fan
- Department of Radiology, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Chen Zhang
- MR Research Collaboration, Siemens Healthineers Beijing China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering Tsinghua University School of Medicine Beijing China
| | - Xunming Ji
- Department of Neurology Xuanwu Hospital, Capital Medical University Beijing China
- Beijing Institute of Brain Disorders, Capital Medical University Beijing China
| | - Qi Yang
- Department of Radiology Beijing Chaoyang Hospital, Capital Medical University Beijing China
- Key Lab of Medical Engineering for Cardiovascular Disease Ministry of Education Beijing China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine Beijing China
- Laboratory for Clinical Medicine Capital Medical University Beijing China
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2
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Zedde M, Napoli M, Grisendi I, Assenza F, Moratti C, Valzania F, Pascarella R. Perfusion Status in Lacunar Stroke: A Pathophysiological Issue. Diagnostics (Basel) 2023; 13:2003. [PMID: 37370898 DOI: 10.3390/diagnostics13122003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
The pathophysiology of lacunar infarction is an evolving and debated field, where relevant information comes from histopathology, old anatomical studies and animal models. Only in the last years, have neuroimaging techniques allowed a sufficient resolution to directly or indirectly assess the dynamic evolution of small vessel occlusion and to formulate hypotheses about the tissue status and the mechanisms of damage. The core-penumbra concept was extensively explored in large vessel occlusions (LVOs) both from the experimental and clinical point of view. Then, the perfusion thresholds on one side and the neuroimaging techniques studying the perfusion of brain tissue were focused and optimized for LVOs. The presence of a perfusion deficit in the territory of a single small perforating artery was negated for years until the recent proposal of the existence of a perfusion defect in a subgroup of lacunar infarcts by using magnetic resonance imaging (MRI). This last finding opens pathophysiological hypotheses and triggers a neurovascular multidisciplinary reasoning about how to image this perfusion deficit in the acute phase in particular. The aim of this review is to summarize the pathophysiological issues and the application of the core-penumbra hypothesis to lacunar stroke.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Federica Assenza
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
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3
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Zedde M, Napoli M, Grisendi I, Assenza F, Moratti C, Valzania F, Pascarella R. CT Perfusion in Lacunar Stroke: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13091564. [PMID: 37174955 PMCID: PMC10177869 DOI: 10.3390/diagnostics13091564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/07/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The main theory underlying the use of perfusion imaging in acute ischemic stroke is the presence of a hypoperfused volume of the brain downstream of an occluded artery. Indeed, the main purpose of perfusion imaging is to select patients for endovascular treatment. Computed Tomography Perfusion (CTP) is the more used technique because of its wide availability but lacunar infarcts are theoretically outside the purpose of CTP, and limited data are available about CTP performance in acute stroke patients with lacunar stroke. METHODS We performed a systematic review searching in PubMed and EMBASE for CTP and lacunar stroke with a final selection of 14 papers, which were examined for data extraction and, in particular, CTP technical issues and sensitivity, specificity, PPV, and NPV values. RESULTS A global cohort of 583 patients with lacunar stroke was identified, with a mean age ranging from 59.8 to 72 years and a female percentage ranging from 32 to 53.1%.CTP was performed with different technologies (16 to 320 rows), different post-processing software, and different maps. Sensitivity ranges from 0 to 62.5%, and specificity from 20 to 100%. CONCLUSIONS CTP does not allow to reasonable exclude lacunar infarct if no perfusion deficit is found, but the pathophysiology of lacunar infarct is more complex than previously thought.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
| | - Federica Assenza
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
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Jiang S, Cui JY, Yan YY, Yang T, Tao WD, Wu B. Association of compromised cerebral perfusion with lenticulostriate artery impairments in the subacute phase of branch atheromatous disease. Ther Adv Neurol Disord 2022; 15:17562864221109746. [PMID: 35813607 PMCID: PMC9260584 DOI: 10.1177/17562864221109746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/09/2022] [Indexed: 02/05/2023] Open
Abstract
Background Purpose: Whether altered cerebral perfusion is associated with the pathogenesis of
single subcortical infarctions (SSIs) in the lenticulostriate artery (LSA)
territory remains unclear. Objective: We aimed to assess whether cerebral perfusion abnormalities are related to
LSA impairments in the subacute phase of SSIs and then to examine their
correlations with etiological subtypes of SSIs. Methods: A total of 110 patients with acute SSIs in the LSA territory were
prospectively recruited between July 2017 and October 2021, and they
underwent magnetic resonance perfusion-weighted imaging (PWI) and
whole-brain vessel-wall imaging (VWI) within 7 days of stroke onset. Based
on VWI, patients were assigned to one of two SSI subtypes: branch
atheromatous disease (BAD, n = 78, 70.9%) or lacunar
infarction related to cerebral small vessel disease (CSVD-related LI,
n = 32, 29.1%). Perfusion maps and LSA morphology were
also quantitatively assessed. Results: Based on PWI, 22 patients (20%) had hypoperfusion and 88 (80%) showed normal
perfusion. Compared with normal individuals, patients with hypoperfusion
showed shorter average LSA length (23.48 ± 4.81 mm versus
25.47 ± 3.74 mm, p = 0.037). Compared with patients with
CSVD-related LI, patients with BAD had significantly lower relative cerebral
blood flow [0.95 (IQR 0.81–1.12) versus 1.04 (IQR
0.92–1.22); p = 0.036] and cerebral blood volume [0.95 (IQR
0.84–1.15) versus 1.14 (IQR 0.97–1.27);
p = 0.020] after adjusting for hypertension, number of LSA
branches, and infarct volume. Conclusion: Compromised cerebral perfusion is associated with impairments in the LSA and
with BAD pathogenesis. Perfusion magnetic resonance imaging can provide
important insights into acute SSI pathophysiology, and it may be useful for
determining the clinical significance of perfusion abnormalities in BAD
occurrence.
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Affiliation(s)
- Shuai Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing-Yu Cui
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yu-Ying Yan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Tang Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Dan Tao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan, China
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Evaluation of clinical relevance and underlying pathology for hemodynamic compromise in acute small subcortical infarction using MRI-based neuroimaging markers. Biomed J 2022; 46:100529. [PMID: 35367449 DOI: 10.1016/j.bj.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/12/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hemodynamic compromise has been observed in patients with acute small subcortical infarction (SSI), and it may play a critical role in the development of early neurological deterioration (END). This study aimed to evaluate the clinical relevance and underlying pathology of hemodynamic compromise in SSI using MRI-based neuroimaging markers. METHODS We retrospectively analyzed data and imaging of previous prospective studies. Patients with acute SSI in penetrating artery territories were recruited, all of whom underwent perfusion MRI within 24 h of stroke onset. We examined the relationships among perfusion defects and neuroimaging markers of small vessel disease, including white matter hyperintensities, cerebral microbleeds, enlarged perivascular spaces (EPVSs) and lacunes. RESULTS One hundred and seven patients were recruited, of whom 21 (19.6%) had END and 55 (51.4%) had visible perfusion defects. Patients with perfusion defects were associated with a higher rate of END (34.5% vs. 3.8%; p < 0.001), higher initial National Institutes of Health Stroke Scale scores (5.4 vs. 3.4, p < 0.001), higher rate of branch atheromatous disease (61.8% vs. 34.6%, p = 0.005) and higher rate of poor outcome at 3 months (40.0% vs. 5.4%; p = 0.005). In multiple logistic regression, perfusion defects were significantly associated with basal ganglia EPVS scores (adjusted odds ratio [aOR]: 3.93; 95% confidence interval [CI]: 1.76-8.77; p = 0.001) and branch atheromatous disease (aOR: 2.64; 95% CI: 1.06-6.60; p = 0.037). CONCLUSION Hemodynamic compromise in acute SSI was highly related to the development of END, basal ganglia EPVS and branch atheromatous disease, suggesting the correlation with underlying pathologies of hypertensive arteriopathy and atherosclerosis.
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Rudilosso S, Rodríguez-Vázquez A, Urra X, Arboix A. The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke. Int J Mol Sci 2022; 23:1497. [PMID: 35163423 PMCID: PMC8835925 DOI: 10.3390/ijms23031497] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 12/21/2022] Open
Abstract
Lacunar infarcts represent one of the most frequent subtypes of ischemic strokes and may represent the first recognizable manifestation of a progressive disease of the small perforating arteries, capillaries, and venules of the brain, defined as cerebral small vessel disease. The pathophysiological mechanisms leading to a perforating artery occlusion are multiple and still not completely defined, due to spatial resolution issues in neuroimaging, sparsity of pathological studies, and lack of valid experimental models. Recent advances in the endovascular treatment of large vessel occlusion may have diverted attention from the management of patients with small vessel occlusions, often excluded from clinical trials of acute therapy and secondary prevention. However, patients with a lacunar stroke benefit from early diagnosis, reperfusion therapy, and secondary prevention measures. In addition, there are new developments in the knowledge of this entity that suggest potential benefits of thrombolysis in an extended time window in selected patients, as well as novel therapeutic approaches targeting different pathophysiological mechanisms involved in small vessel disease. This review offers a comprehensive update in lacunar stroke pathophysiology and clinical perspective for managing lacunar strokes, in light of the latest insights from imaging and translational studies.
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Affiliation(s)
- Salvatore Rudilosso
- Comprehensive Stroke Center, Hospital Clínic of Barcelona, 08036 Barcelona, Spain; (S.R.); (A.R.-V.); (X.U.)
| | - Alejandro Rodríguez-Vázquez
- Comprehensive Stroke Center, Hospital Clínic of Barcelona, 08036 Barcelona, Spain; (S.R.); (A.R.-V.); (X.U.)
| | - Xabier Urra
- Comprehensive Stroke Center, Hospital Clínic of Barcelona, 08036 Barcelona, Spain; (S.R.); (A.R.-V.); (X.U.)
| | - Adrià Arboix
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, 08034 Barcelona, Spain
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7
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Perfusion Defects and Collateral Flow Patterns in Acute Small Subcortical Infarction: a 4D Dynamic MRI Study. Transl Stroke Res 2021; 13:399-409. [PMID: 34648143 PMCID: PMC9046333 DOI: 10.1007/s12975-021-00953-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/09/2021] [Accepted: 10/06/2021] [Indexed: 11/27/2022]
Abstract
The hemodynamic changes of acute small subcortical infarction (SSI) are not well understood. We evaluate the hemodynamic changes and collaterals in acute SSI using perfusion magnetic resonance imaging (MRI). A total of 103 patients with acute SSI in penetrating artery territories were recruited and underwent MRI within 24 h of stroke onset. Using 4D dynamic perfusion MRI, they were divided into three patterns: 25 (24%) with normal perfusion, 31 (30%) with compensated perfusion, and 47 (46%) with hypoperfusion. The development of anterograde or retrograde collaterals was also evaluated. Patients with hypoperfusion pattern had the highest rate of early neurological deterioration (32%, p = 0.007), the largest initial and final infarction volumes (p < 0.001 and p = 0.029), the lowest relative cerebral blood flow (0.63, p < 0.001), and the lowest rate of anterograde and retrograde collaterals (19%, p < 0.001; 66%, p = 0.002). The anterograde collaterals were associated with higher relative cerebral blood volume (0.91 vs. 0.77; p = 0.024) and a higher rate of deep cerebral microbleeds (48 vs. 21%; p = 0.028), whereas retrograde collaterals were associated with higher systolic and diastolic blood pressure (p = 0.031 and 0.020), smaller initial infarction volume (0.81 vs. 1.34 ml, p = 0.031), and a higher rate of lobar cerebral microbleeds (30 vs. 0%; p = 0.013). Both anterograde and retrograde collaterals may play a critical role in maintaining cerebral perfusion and can have an impact on patient clinical outcomes. Further studies are warranted to verify these findings and to investigate effective treatments.
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Hong L, Ling Y, Su Y, Yang L, Lin L, Parsons M, Cheng X, Dong Q. Hemispheric cerebral blood flow predicts outcome in acute small subcortical infarcts. J Cereb Blood Flow Metab 2021; 41:2534-2545. [PMID: 34435912 PMCID: PMC8504947 DOI: 10.1177/0271678x211029884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The association between baseline perfusion measures and clinical outcomes in patients with acute small subcortical infarcts (SSIs) has not been studied in detail. Post-processed acute perfusion CT and follow-up diffusion-weighted imaging of 71 patients with SSIs were accurately co-registered. Relative perfusion values were calculated from the perfusion values of the infarct lesion divided by those of the mirrored contralateral area. The association between perfusion measures with clinical outcomes and the interaction with intravenous thrombolysis were studied. Additionally, the perfusion measures for patients having perfusion CT before and after thrombolysis were compared. Higher contralateral hemispheric cerebral blood flow (CBF) was the only independent predictor of an excellent clinical outcome (modified Rankin Scale of 0-1) at 3 months (OR = 1.3, 95% CI 1.1-1.4, P = 0.001) amongst all the perfusion parameters, and had a significant interaction with thrombolysis (P = 0.04). Patients who had perfusion CT after thrombolysis demonstrated a better perfusion profile (relative CBF ≥1) than those who had perfusion CT before thrombolysis (After:45.5%, Before:21.1%, P = 0.03). This study implies that for patients with SSIs, hemispheric CBF is a predictor of clinical outcome and has an influence on the effect of intravenous thrombolysis.
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Affiliation(s)
- Lan Hong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Yifeng Ling
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Ya Su
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Lumeng Yang
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Longting Lin
- Department of Neurology, Liverpool Hospital, University of New South Wales South Western Sydney Clinical School, The Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Mark Parsons
- Department of Neurology, Liverpool Hospital, University of New South Wales South Western Sydney Clinical School, The Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Xin Cheng
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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9
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Vogels V, Dammers R, van Bilsen M, Volovici V. Deep Cerebral Perforators: Anatomical Distribution and Clinical Symptoms: An Overview. Stroke 2021; 52:e660-e674. [PMID: 34311568 DOI: 10.1161/strokeaha.120.034096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The anatomic distribution of the deep cerebral perforators is considered either a given or subject to enormous variability. Most published overviews on this topic only report findings from a limited number of anatomic dissections, and no attempt has been made to date to provide a comprehensive overview of all published data. A comprehensive literature search was performed on MEDLINE, Embase, and Google Scholar with the help of an information specialist. Three types of studies were included: (1) articles that described the anatomy and distribution territories of perforator groups arising from the arteries of the circle of Willis; (2) studies that evaluated the anatomy of the deep cerebral perforators using imaging techniques; and (3) studies that evaluated either microsurgically or radiologically confirmed perforator occlusion and reported the (magnetic resonance imaging-confirmed) distribution territory of the infarction together with a description of the clinical symptoms associated as a result of the infarction. A total of 2715 articles were screened and 53 were included. Of these, 40 dealt with the anatomic and imaging anatomy of perforator groups (37 reported results of dissections and 3 results of imaging studies), with a total of 2421 hemispheres investigated. Another 13 articles with 680 patients were included that evaluated perforator infarction territories. The deep cerebral perforator distribution shows large variability with poor concordance rates among reported studies, with the exception of the posterior communicating and anterior choroidal artery perforators. Despite the assumption that cerebral perforator anatomy is a given, studies show large variability in the anatomic distribution of various perforator groups. Perforator anatomy and relationships between perforator groups, as well as potential collateral circulation in these territories should be prioritized as a research topic in cerebrovascular disease in the near future.
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Affiliation(s)
- Valerie Vogels
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC Rotterdam, the Netherlands (V.Vogels, R.D., V.Volovici).,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands (M.v.B.)
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC Rotterdam, the Netherlands (V.Vogels, R.D., V.Volovici).,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands (M.v.B.)
| | - Martine van Bilsen
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC Rotterdam, the Netherlands (V.Vogels, R.D., V.Volovici).,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands (M.v.B.)
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC Rotterdam, the Netherlands (V.Vogels, R.D., V.Volovici).,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands (M.v.B.)
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10
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Lin J, Cheng Z, Shi Y, Cai X, Huang L. Evaluating the Velocity and Extent of Cortical Venous Filling in Patients With Severe Middle Cerebral Artery Stenosis or Occlusion. Front Neurol 2021; 12:610658. [PMID: 33897584 PMCID: PMC8060485 DOI: 10.3389/fneur.2021.610658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the velocity and extent of cortical venous filling (CVF) and its association with clinical manifestations in patients with severe stenosis or occlusion of the middle cerebral artery (MCA) using dynamic computed tomography angiography (CTA). Methods: Fifty-eight patients (36 symptomatic and 22 asymptomatic) with severe unilateral stenosis (≥70%) or occlusion of the MCA M1 segment who underwent dynamic CTA were included. Collateral status, antegrade flow, and CVF of each patient were observed using dynamic CTA. Three types of cortical veins were selected to observe the extent of CVF, and the absence of CVF (CVF-) was recorded. Based on the appearance of CVF in the superior sagittal sinus, instances of CVF, including early (CVF1), peak (CVF2), and late (CVF3) venous phases, were recorded. The differences in CVF times between the affected and contralateral hemispheres were represented as rCVFs, and CVF velocity was defined compared to the median time of each rCVF. Results: All CVF times in the affected hemisphere were longer than those in the contralateral hemisphere (p < 0.05). Patients with symptomatic MCA stenosis had more ipsilateral CVF- (p = 0.02) and more delayed CVF at rCVF2 and rCVF21 (rCVF2-rCVF1) (p = 0.03 and 0.001, respectively) compared to those with asymptomatic MCA stenosis. For symptomatic patients, fast CVF at rCVF21 was associated with poor collateral status (odds ratio [OR] 6.42, 95% confidence interval [CI] 1.37-30.05, p = 0.02), and ipsilateral CVF- in two cortical veins was associated with poor 3-month outcomes (adjusted OR 0.025, 95% CI 0.002-0.33, p = 0.005). Conclusions: Complete and fast CVF is essential for patients with symptomatic MCA stenosis or occlusion. The clinical value of additional CVF assessment should be explored in future studies to identify patients with severe MCA stenosis or occlusion at a higher risk of stroke occurrence and poor recovery.
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Affiliation(s)
- Jia'Xing Lin
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Zhong'Yuan Cheng
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Ying'Ying Shi
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xiang'Ran Cai
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Li'An Huang
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China
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11
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Rudilosso S, Laredo C, Mancosu M, Moya-Planas N, Zhao Y, Chirife O, Chamorro Á, Urra X. Cerebral perfusion and compensatory blood supply in patients with recent small subcortical infarcts. J Cereb Blood Flow Metab 2019; 39:1326-1335. [PMID: 29436885 PMCID: PMC6668517 DOI: 10.1177/0271678x18758548] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/05/2017] [Accepted: 01/09/2018] [Indexed: 12/15/2022]
Abstract
Hypoperfusion is the typical perfusion pattern associated with recent small subcortical infarcts of the brain, but other perfusion patterns may be present in patients with these infarcts. Using CT perfusion, we studied 67 consecutive patients who had a small subcortical infarct at a follow-up MRI study to investigate the correlation between the perfusion pattern and the clinical and radiological course. On CT perfusion map analysis, 51 patients (76%) had focal hypoperfusion, 4 patients (6%) had hyperperfusion and the remaining 12 patients (18%) showed no abnormalities. On dynamic sequential imaging analysis obtained from the source perfusion images, 32 patients (48%) had a sustained hypoperfusion pattern, 11 patients (16%) had a reperfusion pattern, and 18 patients (27%) had a delayed compensation pattern. Systolic blood pressure was higher in patients with sustained hypoperfusion although the perfusion pattern was independent of the final volume of infarction. These results reinforce the notion that mechanisms other than hypoperfusion are at play in patients with small subcortical infarcts including the intervention of compensatory sources of blood flow. The ultimate clinical significance of these perfusion patterns remains to be determined in larger series of patients assessed longitudinally.
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Affiliation(s)
- Salvatore Rudilosso
- Functional Unit of Cerebrovascular
Diseases,
Hospital
Clínic, Barcelona, Spain
| | - Carlos Laredo
- Functional Unit of Cerebrovascular
Diseases,
Hospital
Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques
August Pi i Sunyer, Barcelona, Spain
| | - Marco Mancosu
- Department of Neurology, AOU Policlinico
Universitario, Monserrato (Cagliari), Italy
| | - Nuria Moya-Planas
- Institut d'Investigacions Biomèdiques
August Pi i Sunyer, Barcelona, Spain
| | - Yashu Zhao
- Functional Unit of Cerebrovascular
Diseases,
Hospital
Clínic, Barcelona, Spain
| | - Oscar Chirife
- Department of Radiology,
Hospital
Clínic, Barcelona, Spain
| | - Ángel Chamorro
- Functional Unit of Cerebrovascular
Diseases,
Hospital
Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques
August Pi i Sunyer, Barcelona, Spain
| | - Xabier Urra
- Functional Unit of Cerebrovascular
Diseases,
Hospital
Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques
August Pi i Sunyer, Barcelona, Spain
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12
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Assessment of collateral blood flow in patients with distal branch occlusion of the middle cerebral artery. J Neuroradiol 2019; 46:3-8. [DOI: 10.1016/j.neurad.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 06/25/2018] [Accepted: 09/04/2018] [Indexed: 11/20/2022]
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13
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AL-ZGHLOUL MANSOUR, WENZ HOLGER, MAROS MÁTÉ, BÖHME JOHANNES, GRODEN CHRISTOPH, FÖRSTER ALEX. Susceptibility Vessel Sign on T2*-Weighted Gradient Echo Imaging in Lacunar Infarction. In Vivo 2018. [PMID: 29936488 PMCID: PMC6117771 DOI: 10.21873/invivo.112337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND/AIM In stroke due to large vessel occlusion, thrombotic material can be demonstrated by the susceptibility vessel sign (SVS), a hypointense signal on T2*-weighted gradient echo magnetic resonance (GRE) images. In the present study, we evaluated the value of GRE for the detection of perforating artery occlusion in hyperacute lacunar infarction (LI). MATERIALS AND METHODS The presence of SVS on GRE in 58 patients with LI who underwent magnetic resonance imaging within 24 hours after symptom onset was analyzed. RESULTS On diffusion-weighted images (DWI), LI was found in the basal ganglia in 17.2%, internal capsule in 25.9%, corona radiata in 19.0%, thalamus in 32.8%, and brainstem in 5.2%. On GRE a subtle circumscribed hypointense signal at the lower edge of the LI consistent with SVS was detected in 11/58 (19%) patients. Patients with SVS had larger ischemic lesions on DWI (p=0.045). CONCLUSION SVS on GRE may be useful for detection of perforating artery occlusion in a subset of patients with hyperacute LI.
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14
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Al-Zghloul M, Wenz H, Maros M, Böhme J, Groden C, Förster A. Susceptibility Vessel Sign on T2*-Weighted Gradient Echo Imaging in Lacunar Infarction. In Vivo 2018; 32:973-976. [PMID: 29936488 DOI: 10.21873/invivo.11337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM In stroke due to large vessel occlusion, thrombotic material can be demonstrated by the susceptibility vessel sign (SVS), a hypointense signal on T2*-weighted gradient echo magnetic resonance (GRE) images. In the present study, we evaluated the value of GRE for the detection of perforating artery occlusion in hyperacute lacunar infarction (LI). MATERIALS AND METHODS The presence of SVS on GRE in 58 patients with LI who underwent magnetic resonance imaging within 24 hours after symptom onset was analyzed. RESULTS On diffusion-weighted images (DWI), LI was found in the basal ganglia in 17.2%, internal capsule in 25.9%, corona radiata in 19.0%, thalamus in 32.8%, and brainstem in 5.2%. On GRE a subtle circumscribed hypointense signal at the lower edge of the LI consistent with SVS was detected in 11/58 (19%) patients. Patients with SVS had larger ischemic lesions on DWI (p=0.045). CONCLUSION SVS on GRE may be useful for detection of perforating artery occlusion in a subset of patients with hyperacute LI.
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Affiliation(s)
- Mansour Al-Zghloul
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Holger Wenz
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Máté Maros
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes Böhme
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Alex Förster
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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15
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de Havenon A, Southerland AM. In large vessel occlusive stroke, time is brain… but collaterals are time. Neurology 2018; 90:153-154. [PMID: 29282331 DOI: 10.1212/wnl.0000000000004870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Adam de Havenon
- From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; and Department of Neurology and Public Health Sciences (A.M.S.), University of Virginia Health System, Charlottesville.
| | - Andrew M Southerland
- From the Department of Neurology (A.d.H.), University of Utah, Salt Lake City; and Department of Neurology and Public Health Sciences (A.M.S.), University of Virginia Health System, Charlottesville
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16
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Tong LS, Guo ZN, Ou YB, Yu YN, Zhang XC, Tang J, Zhang JH, Lou M. Cerebral venous collaterals: A new fort for fighting ischemic stroke? Prog Neurobiol 2017; 163-164:172-193. [PMID: 29199136 DOI: 10.1016/j.pneurobio.2017.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/03/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022]
Abstract
Stroke therapy has entered a new era highlighted by the use of endovascular therapy in addition to intravenous thrombolysis. However, the efficacy of current therapeutic regimens might be reduced by their associated adverse events. For example, over-reperfusion and futile recanalization may lead to large infarct, brain swelling, hemorrhagic complication and neurological deterioration. The traditional pathophysiological understanding on ischemic stroke can hardly address these occurrences. Accumulating evidence suggests that a functional cerebral venous drainage, the major blood reservoir and drainage system in brain, may be as critical as arterial infusion for stroke evolution and clinical sequelae. Further exploration of the multi-faceted function of cerebral venous system may add new implications for stroke outcome prediction and future therapeutic decision-making. In this review, we emphasize the anatomical and functional characteristics of the cerebral venous system and illustrate its necessity in facilitating the arterial infusion and maintaining the cerebral perfusion in the pathological stroke content. We then summarize the recent critical clinical studies that underscore the associations between cerebral venous collateral and outcome of ischemic stroke with advanced imaging techniques. A novel three-level venous system classification is proposed to demonstrate the distinct characteristics of venous collaterals in the setting of ischemic stroke. Finally, we discuss the current directions for assessment of cerebral venous collaterals and provide future challenges and opportunities for therapeutic strategies in the light of these new concepts.
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Affiliation(s)
- Lu-Sha Tong
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Departments of Physiology, Loma Linda University, School of Medicine, CA, USA
| | - Zhen-Ni Guo
- Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China; Departments of Physiology, Loma Linda University, School of Medicine, CA, USA
| | - Yi-Bo Ou
- Department of Neurosurgery, Tong-ji Hospital, Wuhan, China; Departments of Physiology, Loma Linda University, School of Medicine, CA, USA
| | - Yan-Nan Yu
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiao-Cheng Zhang
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jiping Tang
- Department of Anesthesiology, Loma Linda University, School of Medicine, CA, USA
| | - John H Zhang
- Departments of Physiology, Loma Linda University, School of Medicine, CA, USA.
| | - Min Lou
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
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17
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Gawlitza M, Böhme J, Maros M, Lobsien D, Michalski D, Groden C, Hoffmann KT, Förster A. FLAIR vascular hyperintensities and 4D MR angiograms for the estimation of collateral blood flow in anterior cerebral artery ischemia. PLoS One 2017; 12:e0172570. [PMID: 28234996 PMCID: PMC5325299 DOI: 10.1371/journal.pone.0172570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/23/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess FLAIR vascular hyperintensities (FVH) and dynamic (4D) angiograms derived from perfusion raw data as proposed magnetic resonance (MR) imaging markers of leptomeningeal collateral circulation in patients with ischemia in the territory of the anterior cerebral artery (ACA). METHODS Forty patients from two tertiary care university hospitals were included. Infarct volumes and perfusion deficits were manually measured on DWI images and TTP maps, respectively. FVH and collateral flow on 4D MR angiograms were assessed and graded as previously specified. RESULTS Forty-one hemispheres were affected. Mean DWI lesion volume was 8.2 (± 13.9; range 0-76.9) ml, mean TTP lesion volume was 24.5 (± 17.2, range 0-76.7) ml. FVH were observed in 26/41 (63.4%) hemispheres. Significant correlations were detected between FVH and TTP lesion volume (ρ = 0.4; P<0.01) absolute (ρ = 0.37; P<0.05) and relative mismatch volume (ρ = 0.35; P<0.05). The modified ASITN/SIR score correlated inversely with DWI lesion volume (ρ = -0.58; P<0.01) and positively with relative mismatch (ρ = 0.29; P< 0.05). ANOVA of the ASITN/SIR score revealed significant inter-group differences for DWI (P<0.001) and TTP lesion volumes (P<0.05). No correlation was observed between FVH scores and modified ASITH/SIR scores (ρ = -0.16; P = 0.32). CONCLUSIONS FVH and flow patterns on 4D MR angiograms are markers of perfusion deficits and tissue at risk. As both methods did not show a correlation between each other, they seem to provide complimentary instead of redundant information. Previously shown evidence for the meaning of these specific MR signs in internal carotid and middle cerebral artery stroke seems to be transferrable to ischemic stroke in the ACA territory.
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Affiliation(s)
- Matthias Gawlitza
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | - Johannes Böhme
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maté Maros
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Donald Lobsien
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Dominik Michalski
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Alex Förster
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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18
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Cai Z, He W, Peng CY, Zhou J, Xu QL, Wu ZS. The prevalence of lacunar infarct decreases with aging in the elderly: a case-controlled analysis. Clin Interv Aging 2016; 11:733-8. [PMID: 27307719 PMCID: PMC4887063 DOI: 10.2147/cia.s108166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and purpose Lacunar infarct (LI) is well known as a heterogeneous primary disorder of cerebral small vessel. Compelling results have demonstrated that age is a risk factor to the prevalence of LI. However, the relationship between age and the prevalence of LI remains obscure. It is essential to note the relationship between age and the prevalence of LI through more clinical data. Methods A total of 3,500 patients were included in the case-controlled study. All data were collected from the Examination Center of Magnetic Resonance Imaging, Lu’an People’s Hospital from January 2014 to December 2015. A primary discharge diagnosis of LI was done, and all subjects were evaluated as retrospective data. The relationship between the risk factors and the prevalence of diabetes and the relationship between age and the prevalence of diabetes was analyzed. A chi-square test was used to analyze the associations between different variables. A one-way analysis of variance was used to test the equality of three or more means at one time by using variances. Statistical significance was defined as a P-value of <0.05. Results The one-way analysis of variance demonstrated that the prevalence of LI increased with age before 60 years and decreased with age after 69 years. The same results were found in both the male and the female subjects. These results showed that the age-related risk factors (hypertension, diabetes, cerebral infarct, cardiovascular diseases, smoking, and drinking) have no relationship with the prevalence of LI on the basis of age. There is a significant difference among the different age ranges (P=0.0006). Two-tailed P-value (unpaired t-test) showed the mean significant difference between 30–39 years and 40–49 years (P=0.009) and between 70–79 years and 80–100 years (P=0.0196). F-test (to compare variances) demonstrated that the variances of the different age ranges are significantly different between 30–39 years and 40–49 years (P=0.0002), between 40–49 years and 50–59 years (P=0.0424), and between 70–79 years and 80–100 years (P=0.0003). Conclusion The age-related risk factors (hypertension, diabetes, cerebral infarct, cardiovascular diseases, smoking, and drinking) have no relationship with the prevalence of LI on the basis of age. A decreasing prevalence of LI with aging occurs in the elderly, while the prevalence of LI increases with aging in the young and in adults. This investigation implicates that age is not a risk factor for LI in the elderly.
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Affiliation(s)
- Zhiyou Cai
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan Renmin Hospital, Shiyan, Hubei Province, People's Republic of China
| | - Wenbo He
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan Renmin Hospital, Shiyan, Hubei Province, People's Republic of China
| | - Chuan-Yong Peng
- The Examination Center of Magnetic Resonance Imaging, the Lu'an Affiliated Hospital of Anhui Medical University, Lu'an People's Hospital, Lu'an, Anhui Province, People's Republic of China
| | - Jin Zhou
- The Examination Center of Magnetic Resonance Imaging, the Lu'an Affiliated Hospital of Anhui Medical University, Lu'an People's Hospital, Lu'an, Anhui Province, People's Republic of China
| | - Qi-Lan Xu
- The Examination Center of Magnetic Resonance Imaging, the Lu'an Affiliated Hospital of Anhui Medical University, Lu'an People's Hospital, Lu'an, Anhui Province, People's Republic of China
| | - Zong-Shan Wu
- The Examination Center of Magnetic Resonance Imaging, the Lu'an Affiliated Hospital of Anhui Medical University, Lu'an People's Hospital, Lu'an, Anhui Province, People's Republic of China
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